Stakeholder Engagement

Abstract

Background

Oklahoma law pre-empts local governments from enacting smoking restrictions inside public places that are stricter than state law, but the sovereign status of Oklahoma’s 38 Tribal nations means they are uniquely positioned to stand apart as leaders in the area of tobacco policy.

Purpose

To provide recommendations for employing university–Tribal partnerships as an effective strategy for tobacco policy planning in tribal communities.

Methods

Using a community-based participatory research approach, researchers facilitated a series of meetings with key Tribal stakeholders in order to develop a comprehensive tobacco policy plan. Ongoing engagement activities held between January 2011 and May 2012, including interdepartmental visits, facility site tours, interviews, and attendance at tribal activities, were critical for fostering constructive and trusting relationships between all partners involved in the policy planning process.

Results

The 17-month collaborative engagement produced a plan designed to regulate the use of commercial tobacco in all Tribally owned properties. The extended period of collaboration between the researchers and Tribal stakeholders facilitated: (1) levels of trust between partners; and (2) a steadfast commitment to the planning process, ensuring completion of the plan amid uncertain political climates and economic concerns about tobacco bans.

Conclusions

Extended engagement produced an effective foundation for policy planning that promoted collaboration between otherwise dispersed Tribal departments, and facilitated communication of diverse stakeholder interests related to the goal of tobacco policies. The findings of this study provide useful strategies and best practices for those looking to employ Tribal–university partnerships as strategies for tobacco control planning and policy-based research.

Introduction

In 2012, Oklahoma Governor Mary Fallin signed Oklahoma Executive Order 2012-01, prohibiting the use of tobacco on all state properties¹ However, Section 1-1527 of Title 63 in the Oklahoma statutes still preempts local governments from enacting smoking restrictions inside public places that are stricter than state law. The sovereign status of federally recognized American Indian Tribes in the U.S. means that Tribes are exempt from such statewide bans and from state-imposed preemption. Oklahoma’s 38 Tribal Nations are thus uniquely positioned to stand apart as leaders in the area of tobacco policy given their capacity to enact stricter and more comprehensive tobacco bans than state laws. This capacity to reduce exposure to environmental tobacco smoke for their citizens, employees, and patrons and affect social norm change related to commercial tobacco use is significant, given that American Indian/Alaska Natives currently have the highest prevalence rate (38.5%) of smoking in the U.S.²

In January 2011, representatives from an Oklahoma Tribal Nation and University of Oklahoma researchers established a joint initiative to develop a policy prohibiting the use of commercial tobacco in all of the Tribe’s properties. Such a policy would be the first of its kind among Oklahoma Tribes, making these deliberations a potentially sensitive task. The aim of this paper is to provide recommendations for employing Tribal–university partnerships as an effective strategy for tobacco policy planning.

Methods

Between January 2011 and May 2012, University of Oklahoma researchers facilitated stakeholder meetings with representatives from an Oklahoma Tribe for purposes of planning and developing a comprehensive tobacco policy. IRB approval was secured from the University and the Tribe prior to data collection. The planning process was informed by a community-based participatory research (CBPR) approach that reinforces the importance of power sharing and “promotes the idea that collaborative partnerships enable…more prominent roles for community partners in the ownership and control of project outcomes.”^3,4 Formal permission to study the planning process itself rested on the provision that full anonymity of the participating individuals and Tribal entity be preserved, hence the omission of descriptive identifiers and demographic information related to the participating Tribal Nation in this study. Tribal leadership identified the stakeholders with whom the researchers would conduct the collaborative process of policy planning. Tribal stakeholders established early that the components of the final policy product would be proprietary given the sensitive and unprecedented nature of this kind of policy work in Tribal communities at that time.

During the 17-month engagement period, researchers and Tribal stakeholders held over 25 meetings focused on the development of the policy itself, with all collaborators contributing expertise and data related to economic impacts, description of facilities and infrastructure, program preparedness, numbers of employees, health promotions needs assessments, and a thorough review of existing policies and interdepartmental priorities. Additional engagement activities included interdepartmental visits, facility site tours, one-on-one interviews, electronic data sharing, and collaboration on written and oral presentations.

Results

The result of this process was a fully comprehensive plan prohibiting the use of commercial tobacco in all Tribally owned, leased, and occupied properties. The plan was distributed to all collaborators, who then delivered the plan to their immediate supervisors and to Tribal leadership. To date, the completed plan has not been implemented as formal policy. Follow-up visits with community partners suggests that Tribal leadership has not formally reviewed or adopted the plan, but continued efforts are being made to bring visibility to the importance of adopting a comprehensive tobacco policy.

Successful completion of the plan was due, in part, to the willingness of partners to commit to extended periods of collaboration. Prolonged engagement and trust building between researchers and Tribal partners, especially among representatives of disparate Tribal departments, was effective as a model for promoting collective ownership of the actual planning process, ensuring completion of the plan amid changes in leadership support and personnel, and in spite of concerns over economic impact from tobacco bans.

Discussion

Tobacco is central to many traditional practices for Tribal communities.⁵ Tobacco control in Native populations is further compounded by cultural, historic, and economic factors, including the fact that many Tribes participate in the operation of Tribal smoke shops.^6–8 Additionally, Tribal casinos, because they are exempt from statewide tobacco bans, often “represent the last vestige of indoor smoking”⁹ in public spaces in otherwise smoke-free or -restrictive states. Gaming is fast becoming one of the most economically consequential undertakings for some, but not all, federally recognized American Indian tribes. In 2010 alone, gross revenue from all Indian gaming peaked at $26.5 billion nationally,¹⁰ and Oklahoma’s 113 Indian gaming facilities generated over $3 billion in gaming revenue and over $455 million in non-gaming revenue.¹¹ Tribal stakeholders in this study, particularly those representing business and gaming departments, expressed concern that tobacco bans would negatively impact gaming revenues. The success of this planning process rested on the entire group’s willingness to shape the final policy in ways that addressed these and other departmental concerns.

Tribal stakeholders expressed tremendous concerns related to data sharing and the disclosure of policy details to anyone outside of the immediate planning group; these concerns speak to the longstanding mistrust of researchers, particularly non-Native researchers, that exists in many Native communities.^12–16 Native communities throughout the U.S. have experienced a deep “history of neglect, exploitation, and deceit” that has established “a legacy of mistrust of outside interference in Tribal affairs.”¹⁷ This study’s extended engagement process established trust that allowed non-Native researchers to broach sensitive Tribal concerns and ensured measures were in place to protect individuals who feared backlash for participating in politically sensitive policy work.

As with many governments, changes in leadership can greatly influence policy decisions and be particularly disruptive in Tribal communities given the close intertwining of governance and families, communities, and political factions.^17–19 In this project, Tribal leadership changes directly impacted the policy planning activities through discontinued participation and increased anxiety among stakeholders, delays associated with personnel replacements, and changing leadership priorities. Despite these disruptions, and because of an established foundation of trust and cooperation, policy planning resumed in a manner that provided a sense of stability and purpose in otherwise unstable political situations.

Conclusions

Guided by principles of CBPR, researchers and Tribal stakeholders produced a comprehensive tobacco policy that “neither [partner] could have developed on its own” by working “together to generate knowledge and solve local problems.”¹⁹ The policy planning process was not unilaterally directed by either researcher or stakeholder interests, but was constantly molded according to stakeholder dynamics. Tobacco policy planning in Tribal Nations involves a multifaceted group of stakeholders whose diverse interests shape the planning process in significant ways. The findings of this study point to the importance of establishing trust, interdepartmental engagement, and dealing with changes in political climates as best practices for those looking to employ Tribal–university partnerships as strategies for tobacco control and policy-planning initiatives.